Protocol Administration
ProtocolIRBApprovedDate
date
InformedConsentFormSignedDate
date
TreatmentProjectedBeginDate
date
PatientSignedDischargeMedicalRecordDate
date
InstitutionContactPersonName
text
ContactPersonTelephoneNumber
text
ContactPersonFaxNumber
text
Patient Demographics/pre-treatment Characteristics
PatientInitialsName
text
PatientBirthDate
date
PatientPersonSocialSecurityNumber
text
PatientMedicalRecordNumber
text
PatientGenderCategory
text
PatientRaceCategory
text
PatientEthnicGroupCategory
text
Patient Demographics/pre-treatment Characteristics2
PerformanceStatusAssessmentEasternCooperativeOncologyGroupScale
text
PatientPaymentType
text
Patient Demographics/pre-treatment Characteristics3
DiseaseDescriptionText
text
PatientAddressPostalCode
text
PatientAddressCountryName
text
Certification Of Eligibility And Protocol Design
PatientEligibilityIndicator
text
Protocol Design
ClinicalResearchAssociateResponsiblePersonName
text
ClinicalResearchAssociatePersonTelephoneNumber
text
ClinicalResearchAssociatePersonEmailAddressText
text
Registration Information
PatientRegistrationDate
date
PatientCALGBIdentifierNumber
text
PatientParticipatingIdentifierNumber
text
RegisteringPersonIdentifierSignatureName
text